ArticleAIDS (London, England)2019
The HIV diagnostic assistant: early findings from a novel HIV testing cadre in Malawi.
Article in AIDS (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.
- A Systematic Review of HIV Testing Implementation Strategies in Sub-Saharan African Countries.AIDS and behavior · 2022Pooled it
- Assessing Fidelity to HIV Index Case Testing Protocols in Malawian Clinical Settings: Results From a Cluster Randomized Controlled Trial.Journal of the International AIDS Society · 2026Trial
- Effect of a digital training package on clinical outcomes in Malawi's index case testing programme: a cluster randomised controlled trial.BMJ global health · 2026Trial
- Leveraging infant visit PrEP screening INtegration & tasK shifting to improve post-partum HIV prevention in Malawi (LINK): a cluster-randomized trial evaluation of a postpartum HIV prevention package among breastfeeding women in Malawi.BMC health services research · 2025Trial
- Trial
- Task shifting of point-of-care testing to lay health workers in rural primary health facilities in Nsanje, Malawi.Global health action · 2026Article
- Understanding how digital training enhances healthcare worker perceptions of HIV index case testing: a qualitative explanatory analysis.Research square · 2026Article
- Article
- Anticipated Acceptability of Blended Learning Among Lay Health Care Workers in Malawi: Qualitative Analysis Guided by the Technology Acceptance Model.JMIR formative research · 2025Article
- Task sharing for point-of-care testing: Review of national health policies and implementation landscape in 19 African countries.PLOS global public health · 2025Article
- Examining the feasibility of assisted index case testing for HIV case-finding: a qualitative analysis of barriers and facilitators to implementation in Malawi.BMC health services research · 2024Article
- Article
- Phone-based psychosocial counseling for people living with HIV: Feasibility, acceptability and impact on uptake of psychosocial counseling services in Malawi.Global mental health (Cambridge, England) · 2024Article
- Does a youth intern programme strengthen HIV service delivery in South Africa? An interrupted time-series analysis.Journal of the International AIDS Society · 2023Article
- Development of a Blended Learning Approach to Delivering HIV-Assisted Contact Tracing in Malawi: Applied Theory and Formative Research.JMIR formative research · 2022Article
- The association between health workforce availability and HIV-program outcomes in Côte d'Ivoire.Human resources for health · 2022Article
- Lay testing cadres and point-of-care diagnostic tests for HIV and other diseases: An essential combination in health service delivery.PLoS medicine · 2021Article
- Leveraging routine viral load testing to integrate diabetes screening among patients on antiretroviral therapy in Malawi.International health · 2021Article
- Understanding the influence of health systems on women's experiences of Option B+: A meta-ethnography of qualitative research from sub-Saharan Africa.Global public health · 2021Article
- Accelerating progress towards the elimination of mother-to-child transmission of HIV: a narrative review.Journal of the International AIDS Society · 2020Review
Corrections and comments
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Authors and funding
11 authors at 7 institutions in 2 countries.
Funding
Abstract
objectivesIn 2015, Malawi piloted the HIV diagnostic assistant (HDA), a cadre of lay health workers focused primarily on HIV testing services. Our objective is to measure the effect of HDA deployment on country-level HIV testing measures.
designInterrupted time series analysis of routinely collected data to assess immediate change in absolute numbers and longitudinal changes in trends.
methodsData from all HDA sites were divided into two periods: predeployment (October 2013 to June 2015) and postdeployment (July 2015 to December 2017). Monthly rates of several key HIV testing measures were evaluated: HIV testing, including all tests done, new positives, and confirmatory testing. Syphilis testing at antenatal clinic (ANC) and early infant diagnosis were also assessed.
findingsThe number of patients tested for HIV per month increased after HDA deployment across all sex, age, and testing subgroups. The number of tests immediately increased by 35 588 (P = 0.031), and the postintervention trend was significantly greater than the preintervention slope (+3442 per month, P = 0.001). Of 7.4 million patients tested for HIV in the postdeployment period, 2.6 million (34%) were attributable to the intervention. The proportion of new positives receiving confirmatory tests increased from 28% preintervention to 98% postintervention (P < 0.0001). Syphilis testing rates at ANC improved, with 98% of all tests attributable to HDA deployment. The number and proportion of infants receiving DNA-PCR testing at 2 months experienced significant trend increases (P < 0.0001).
interpretationHDA deployment is associated with significant increases in total HIV testing, identification of new positives, confirmatory testing, syphilis testing at ANC, and early infant diagnosis testing.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.